Edward Khantzian - Academia.edu (original) (raw)

Papers by Edward Khantzian

JAMA: The Journal of the American Medical Association, 1987

ABSTRACT This book is well suited for serious students of the mind who seek a perspective on the ... more ABSTRACT This book is well suited for serious students of the mind who seek a perspective on the intellectual ferment going on in contemporary psychoanalysis. At the same time, it provides a scholarly and clear presentation of the history of ideas and scientific method in psychological thought in particular and in medicine in general. John Gedo's book about psychoanalysis demonstrates how temperament influences our concepts and affects the methods we employ, which in turn helps us to identify and understand what is important in psychological life.Psychoanalysis has been called "the impossible profession." It is just as true to say it is a profession that provides infinite possibilities for self-knowledge and transformation. Psychoanalysis is a method of treatment for mental dysfunction and suffering and a method of studying mental life. Thus, it is a calling that tugs at us as practitioner-healer at the same time that it tugs at us as

New England Journal of Medicine, 1986

Neuropsychoanalysis, 2003

ABSTRACT In contrast to early psychoanalytic theory, which stressed pleasurable/aggressive drives... more ABSTRACT In contrast to early psychoanalytic theory, which stressed pleasurable/aggressive drives and the symbolic meaning of drugs to explain their appeal, a modern psychodynamic perspective of substance-use disorders (SUDs) places greater emphasis on intolerable painful or confusing affects that make addictive drugs compelling. A psychotherapeutic relationship rooted in a psychodynamic approach yields valuable data on the nature of a person’s distress and deficits in psychological (ego/self) structures that predispose individuals to addiction. An evolving psychodynamic perspective, spanning 30 years, is presented wherein addictions have been considered as (1) a special adaptation, (2) an attempt to self-medicate painful or confusing emotions, (3) an overarching problem in self-regulation, and finally (4) a reflection of disorder in personality organization. This evolving perspective more likely than not should and does complement and resonate with other perspectives. A modern psychodynamic perspective of SUDs adds an important dimension to unraveling the biopsychosocial equation involved in understanding addictive vulnerability.

JAMA: The Journal of the American Medical Association, 1998

JAMA: The Journal of the American Medical Association, 1985

ABSTRACT OUR CALL as physicians to the profession of medicine involves complex motives. It is pro... more ABSTRACT OUR CALL as physicians to the profession of medicine involves complex motives. It is probably safe to say, however, that for most of us, making people healthier, taking care of patients, or repairing them plays some part. As we attend to the injuries and dysfunctions of our patients, we also attend to our own. The healing traditions constantly challenge us and our patients to address the need for restoration and well-being.I believe that most physicians are motivated by idealism and commitment in choosing medicine, and that our choice is rooted in a desire to offer comfort and care to others. In fact, much of our stress and burdens, as well as our satisfactions, derive from this deeper personal and professional meaning in our lives.The substance-dependent physician is a casualty of life's human challenges and the special challenges of the profession of medicine. Addiction can best be understood, I

Recent Developments in Alcoholism an Official Publication of the American Medical Society on Alcoholism the Research Society on Alcoholism and the National Council on Alcoholism, Feb 1, 1989

AA's success rests on its ability to establish and maintain abstinence. This basic and es... more AA's success rests on its ability to establish and maintain abstinence. This basic and essential accomplishment has tended to detract from the fact that AA is successful in good part because it is a sophisticated psychosocial form of treatment that addresses human psychological vulnerabilities that alcoholics and others share related to problems of self-regulation. The "character defects" that AA addresses are related to attitudes about self and others that are embodied in character traits and styles that make interdependence, experience, and expression of feelings and self-care problematical and difficult. AA confronts these "defects" by effectively advocating surrender, acceptance of a Higher Power, and challenging human self-centeredness. In its insistence on openness, support, sharing of experiences, and mutual concerns, AA imaginatively employs group psychology to address vulnerabilities in self-governance and problems in regulating feelings and self-care.

Recent Developments in Alcoholism an Official Publication of the American Medical Society on Alcoholism the Research Society on Alcoholism and the National Council on Alcoholism, Feb 1, 1990

Addicts and alcoholics suffer vulnerabilities and deficits in self-regulation. A principal manife... more Addicts and alcoholics suffer vulnerabilities and deficits in self-regulation. A principal manifestation of their self-regulation disturbances is evident in the way they attempt to self-medicate painful affect states and related psychiatric problems. Individuals select a particular drug based on its ability to relieve or augment emotions unique to an individual which they cannot achieve or maintain on their own. Addicts and alcoholics usually experiment with all classes of drugs, but discover that a particular drug suits them best. Usually, painful affect states interact with other problems in self-regulation involving self-esteem, relationships, self-care, and related characterological defenses, making it more likely that addicts will experiment with and find the action of a particular drug appealing or compelling. Stimulants have their appeal because their energizing properties relieve distress associated with depression, hypomania, and hyperactivity; opiates are compelling because they mute and contain disorganizing affects of rage and aggression; and sedative hypnotics, including alcohol, permit the experience of affection, aggression, and closeness in individuals who are otherwise cut off from their feelings and relationships.

Journal of Substance Abuse Treatment, 1995

American Journal of Psychiatry, Jul 1, 1983

Journal of Groups in Addiction Recovery, 2006

ABSTRACT The harm reduction paradigm has been proposed as a beneficial therapeutic alternative fo... more ABSTRACT The harm reduction paradigm has been proposed as a beneficial therapeutic alternative for substance dependent individuals who cannot or do not readily achieve abstinence. A brief discussions is presented on how this alternative has fostered another unproductive polarized controversy in the addiction field. The author presents a group vignette in which an open and honest interaction unfolds among the members about the advantages and possible problems of both the harm reduction and abstinence models. A case is made of the need for alternatives to abstinence, such as harm reduction, when patients cannot or do not adopt it, especially early in recovery.

Journal of the American Academy of Psychoanalysis, 1987

American Journal of Psychotherapy, Feb 1, 1974

ABSTRACT

American Journal of Psychotherapy, Feb 1, 1980

Evidence is reviewed for considering an ego-impairment/psychopathologic basis for understanding a... more Evidence is reviewed for considering an ego-impairment/psychopathologic basis for understanding alcoholism. Despite conflicting reports, there is also evidence that psychotherapeutic and psychopharmacologic treatment may be effective. The author describes his management and treatment of alcohol problems based on an appreciation of the alcoholic's ego impairments and other psychopathology.

In contrast to early psychodynamic formulations of addictions which stressed pleasure seeking or ... more In contrast to early psychodynamic formulations of addictions which stressed pleasure seeking or self-destruction, a modern psychodynamic perspective places greater emphasis on understanding addicts' disturbances in regulating their internal emotional life and adjustment to external reality. Effective treatment rests on providing interventions and responses that appropriately respond to addicts deficits in regulating affects and behavior. Treatment modalities must keep needs for comfort, control, and safety as the highest priorities, especially initially, in considering the choice of treatment or combination of treatments which are adopted or prescribed. The concept of a primary care therapist is advanced in which a single clinician takes responsibility for holding patients to other interventions and for monitoring which elements or combinations are most helpful. Benefits, pitfalls, limitations, and risks are considered for individual psychotherapy, self-help groups (i.e., AA and NA), and group psychotherapy. The role of psychopharmacologic approaches are considered as they pertain to psychotherapy.

Nida Research Monograph, May 1, 1977

... To summarize how this capacity evolves, the individual gradually incorporates into a sense of... more ... To summarize how this capacity evolves, the individual gradually incorporates into a sense of the self and into the ego the parents' protective role and their function as a stimulus barrier. ... Despite all good intentions, he found himself reverting to previous addictive behaviour. ...

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The self-medication hypothesis of addictive disorders derives primarily from clinical observation... more The self-medication hypothesis of addictive disorders derives primarily from clinical observations of patients with substance use disorders. IndMduals discover that the specific actions .or effects of each class of drugs relieve or change a range of painful affect states. SeIf:-medication factors occur In a e;ontext of self-regulation wlnerabllitiesprimarily difficulties in regulating affects, self-esteem, relationships, and self-care. Persons with substance use disorders suffer in the extreme with theIr feelings, either being overwhelmed with painful affects or seeming not to feel fhelr emotions at .all. Substances of abuse help such individuals to relieve painful affects or to experience or control . emotions when they are absent or confusing. DlagnQSticstudies provide evidence that variously supports and falls to support a self-medication hypothesis of addictive disorders. The cause-consequence controversy Involving psychopathology and substance use! abuse Is reviewed and critiqued. In contrast, cOnical observations and empirical studies that focus on painful affects and subjective states of distress more consistently suggest that such states of suffering are important psychological determinants in using, becoming dependent upon, and relapsing to addictive substances. Subjective states of distress and suffering involved in motives to self;'medlcate with substances of abuse. are cQnsldered with respect to nicotine dependence and to schizophrenia and posttraumatic stress disorder comorbld with a substance use disorder, (I:farvard Rev Psychlatry.1997;4:.231-44.) The notiOn of "self-medication" is one of the most intuitively appealing theories about drug abuse. According to this hypothesis, 1 drug abuse begins as a partially successful attempt to assuage painful feelings. This does not mean . seeking "pleasure" from the use of drugs. Rather, individuals predisposed by biological or psychological vulnerabilities

The author advocates that a clinician play the role of a primary care therapist (PCT) for substan... more The author advocates that a clinician play the role of a primary care therapist (PCT) for substance abusers to assure that appropriate treatment interventions are provided to meet patient needs. In treating substance abusers, the PCT must be concerned about patients' needs for control, containment, contact, and comfort, especially initially, but also in an ongoing way. The PCT functions in direct, coordinating, and monitoring roles in order to optimally provide and combine psychotherapeutic and self-help elements.

Journal of Substance Abuse Treatment, Feb 1, 1989